Does discrimination prevent transgender and gender diverse people from seeking healthcare? A nationwide cohort study in South Korea

Introduction: Using Asia’s first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea. Methods: We analyzed a two-wave (2020–2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD. Results: Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21–2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD. Conclusion: In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.